From Citizen-Led Ballot Initiative to Community-Centered Solutions for Mental Health and Substance Misuse

Grantmakers in Health

Views from the Field

Lorez Meinhold, Executive Director, Caring for Denver Foundation

A need to do better for those with mental health and substance misuse needs was the driving force behind the creation of Caring for Denver Foundation, a nonprofit foundation funded through a city municipal ballot. In 2018, Rep. Leslie Herod championed a citizen-led ballot initiative in Denver, Colorado. She saw firsthand what a lack of available services can do. Her sister has been in and out of the criminal justice system for at least 20 years, due in large part to mental health and substance abuse challenges. Her sister, like so many, never got adequate care. We must do better.

Denver voters agreed. On November 6, 2018, 70 percent of voters approved the ballot initiative. For every $100 spent in Denver, 25 cents now goes toward addressing mental health and substance misuse. This equates to more than $35 million available (dependent on the economy) to fund behavioral health supports. The ordinance required a nonprofit organization administer these funds to be nimble and responsive to community needs. Today, Caring for Denver Foundation is up and running. Our mission is to address Denver’s mental health and substance misuse needs by growing community-informed solutions, dismantling stigma, and turning the community’s desire to help into action. In less than one year of operation, we have funded 41 organizations and five City agencies and provided $17.3 million in funding to the Denver community.

In our first few months as an organization, we prioritized connecting with the Denver community to gather perspectives and insights on what our initial funding priorities should be. These outreach events, both in-person, over the phone and online (in English and Spanish), led to engagement of 1,600 residents. We relied on their knowledge, experience, and collaboration to identify and inform our funding areas of:

  • Alternatives to Jail: Greater supports, connections, practices, and opportunities to redirect people with mental health and substance misuse crises away from the criminal justice system.
  • Community-Centered Solutions: Use community knowledge, strengths, and resources to foster local connectedness and support.
  • Youth (0-26): The earlier and more resources we can provide Denver’s youth, the less crisis and need for costly services later in life.
  • Care Provision: Better support access to quality mental health and substance misuse care at the right time.

We continue to partner with community in many aspects of our work, seeking involvement and feedback in our processes and decisionmaking. We center our work on outcomes that put communities—and their potential—first.One of the first programs championed in partnership with community leaders and funded was the Support Team Assisted Response (STAR) pilot program modeled after a similar program in Eugene, Oregon. The Denver STAR program, launched in June, is currently dispatching a paramedic and a mental health professional—instead of police—in a mobile unit to respond to someone in a mental health or substance misuse crisis, stabilize them, deescalate the situation, and divert individuals from the criminal justice system by connecting them with the appropriate community resources for ongoing care. This program is investing in a community-driven priority of ensuring persons with mental health and substance misuse issues have alternatives to jail that match and meet their needs.The STAR program is just one example of the alternative and innovative ways Caring for Denver is approaching streamlining access to support services and dismantling stigma associated with mental health and substance misuse. We have been keenly focused on identifying and using learning to understand the progress and outcomes of our investments and to help determine what is working and where opportunities exist for evolving as a foundation.Perhaps our biggest learning to date is that putting community at the center is transformational. Prioritizing partnership with community and those with lived experience has been pivotal in our work, helping us build community trust and providing opportunities to invest in community-driven resources and ideas we would not have been connected to otherwise. We are working hard to include the community in defining funding areas, refining visions for investment, proposal review, storytelling and messaging, and defining our role in the community with respect to equity. Some of our learnings from and with community to date include:

Stories build community will and art is an intervention.

  • One of the primary ways the campaign garnered significant support was storytelling. Stories revealed in art, music, and spoken word helped Denver residents find commonality in a way that had, and continues to have, the power to normalize shared struggles with mental health and substance misuse. We are continuing to promote stories as a connector.
  • Community recognizes the arts as powerful solutions for substance misuse and mental health and requested funding be prioritized for innovative and authentic projects that promote the arts as prevention and intervention tools.

Racial disparities are real and should drive investment if solutions are to be sustainable.We heard from trusted community thought partners and community that:

  • Racial and ethnic disparities are a defining characteristic of our criminal justice system, so we must prioritize solutions created by Black, Indigenous and people of color, who are disproportionately impacted.
  • Involving community-based leaders and lived experience, like peer navigation and mentorship, is a key to success.
  • Community wanted Caring for Denver to make public that addressing disparities is a priority. A public commitment was as necessary for building trust as our financial investment, and we are now defining the actions that will ensure we make good on that commitment.

Community is central for healing and it is not always a place.

  • Community members told us more mental health and substance misuse supports need to be locally available and community-authored, helping to ensure people can access supports in times and spaces that make sense for their schedules, life experiences, and cultural histories.
  • We also heard the importance of defining community as more than just a place. It can be a group of belonging defined by the commonalities of the people involved rather than the geography in which they reside.

Learning is a welcomed and helpful approach in the funding space.

  • Instead of requiring logic models and evaluation plans upfront in applications, we have asked grantees to have conversations with us about the work they plan to do and the outcomes they hope to achieve. These conversations have been full of excitement, motivation, and nuances often not described in written applications. In exploring work with grantees, we are discovering important factors in their work (the “secret sauce”) to measure and learn about that may have otherwise been left out.
  • Grantees already have great insights and questions about their work that are right-sized and meaningful for supporting progress, improvements, and adaptations. By taking opportunities to listen to their ideas and expertise, we are more clearly understanding their work. This listening is also shedding light on the community contexts, both facilitating and creating barriers to change. By having a more realistic understanding of the current system from those deeply impacted by it, we hope to improve and refine our funding strategies to address systems changes that promote long-term grantee success.
  • As an organization, we have fully committed to being a learning foundation. We have chosen to take the same learning approach internally, and we include community feedback in our learning. We have been able to refine our funding application, organizational strategy and actions in real-time, and create an organizational culture that values learning and reflection.

In the coming months, we are eager to start assessing the progress of the Foundation’s investments. After all, investments only matter if they are meaningful. This fall, we will evaluate our investments in community supports to address COVID-related trauma, mental health and substance misuse needs, and start our first learning cycles with our Alternatives to Jail grantees. We understand these issues are complex.  We don’t expect to see shifts in the community overnight, but we do expect to be able to show the beginnings of positive changes. We look forward to sharing what we learn with the Denver community and with other foundations as we continue to support community solutions to addressing mental health and substance misuse needs.